SLOAN | Dems would make our costly mess of a health care system costlier and messier
Author: Kelly Sloan - November 1, 2018 - Updated: October 31, 2018
Of the sundry issues floating about this high political season, one which seems to most animate Democrats (aside from more abstract concerns such as hatred for the president) is health care, and it is one which has invaded the most high-profile of Colorado’s state races, in particular that for governor.
By “health care,” of course, we mean not so much delivery of health services but who will pay for it. By which, of course, we generally mean “someone else.” Since no one has yet managed to concoct a government program ambitious or transformative enough to simply eliminate expenses, there is still no such thing as free health care. There is, however, such a thing as heath care that is paid for by someone else, and that (presuming you are not the “someone else”) is an appealing concept indeed. So any discussion of health care policy boils down to who that “someone else” is.
The left-wing of the Democratic Party, led nationally by Bernie Sanders and Elizabeth Warren, has resurrected the idea of “Medicare for All,” the lofty goal of “solving” the health care expense problem by employing the simple expedient of having government pay for it all, an idea that has been ostentatiously adopted by some local candidates.
It is unsurprising to witness the Democrats trotting out that line, insofar as it boasts a built-in reductionist appeal to those who lack the time or inclination to analyze beyond the title. Who, after all, does not support the general concept of everybody having health coverage? Especially when the government pays for it?
So off you go, and you finance this, naturally enough, by taxing the rich. But now we encounter a dilemma; there is not enough untaxed wealth in the upper strata to generate the amounts needed. You could tax everyone making more than, say, $250,000 a year at a rate of 95 percent and not even come close to covering the cost. That leaves the middle class.
But of course, there is only so much you can extract from the middle class; and at any rate, in Colorado, you have to ask their permission before you can impose confiscatory tax rates on them. So you look about and find the only mechanism remaining to control cost is to restrict supply and access.
The central problem associated with the inflation of health care costs is overutilization; as a society we over-treat ourselves, mostly because there is a disconnect between what health care costs and what we pay for it. A certain procedure or pill may cost, say, $1,000, but virtually no one pays that. For most people, the bulk is paid by an employer, insurance, or the government (through Medicaid or Medicare). When the price is hidden, demand is artificially created; subsidization encourages use. Single-payer, Medicare-for-all, whatever you wish to call it, exacerbates this situation by extending the subsidy… well, to all. But with no mechanism with which to ration its utilization – price is taken out of the mix – and as the money runs out to pay for the gestating demand, supply necessarily suffers. The egregious wait times in Canada are not because Canadian doctors cannot figure out how to deliver timely care.
We have hypnotized ourselves into accepting as axiomatic that health care is a “right.” But if it is true to say that everyone in America has a “right” to health treatment, then the corollary is that everyone has the concomitant duty to provide that treatment, calling into question the X-ray technician who demands to be compensated for his or her time and skills. This is the source of a great deal of mischief within the health services realm. For instance, we all acknowledge, or should, that an individual’s psychiatric well-being is a legitimate health issue; should it not then follow that aesthetic concerns which can have an effect on psychological welfare – baldness or wrinkles, for example – are likewise legitimate health issues and their treatment worthy of the exercise of our right – that is, forwarding to the government the bill for Rogain or Botox injections?
It’s helpful to evaluate how well we are handling the segment of our health care that is already single-payer. Fully 40 percent of health care in the state can be lumped into that category – mainly Medicare and Medicaid. Since the state took the foolhardy step of expanding the Medicaid rolls, that program alone eats up roughly 1/3 of the state budget, a number that will expand as health care costs continue to inflate and federal largesse wanes, as it inevitably must. Even then the state is not paying its Medicaid bill in full, shifting as it does some 30 percent of its costs on to the private insurance market.
The health care system is a mess, and Democrats are hitching themselves to a plan to make it even messier and more expensive. It’s a symptom of our sound-bite culture that Bernie Sanders acolytes have an easier time advertising plans to exacerbate the problem than Republicans do in offering to tame it.